REPUBLIC OF THE PHILIPPINES )
PROVINCE OF QUEZON ) S.S.
CITY OF LUCENA )
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AFFIDAVIT OF SOLE CUSTODY
I, RIZZA ZUBIETO ESTABLE, of legal age, single, Filipino, and a resident of St.
Peter II Subdivison, Lucena City, Quezon, Philippines, after having been duly sworn in
accordance with law, hereby depose and state, that:
1. I am the biological mother of JAN ANDREI ESTABLE RUBICO who was born out of
wedlock on December 18, 2007 at Lucena United Doctor’s Hospital, Lucena City,
Quezon, Philippines, copy of the authenticated Certificate of Live Birth issued by
the Philippine Statistics Authority (PSA) is hereto attached as Annex “A”;
2. That I am not married to the father of my son JAN ANDREI nor lived together as
husband and wife since his birth and;
3. That I am the sole guardian and has sole custody of the said child and that:
a) There is no Court Order giving the father/mother or any other person
Guardianship over the said child;
b) That I have not entered into any arrangement or agreement which has the
effect of making, or purports to make the father/mother or any other person
guardian of the said child jointly with me;
c) That no other person is a guardian by operation of law;
d) That no other circumstances exist whereby there is a guardian.
5. That this affidavit is executed for the purpose of attesting to the truth of the
foregoing facts and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of June at
Lucena City, Quezon, Philippines.
RIZZA ZUBIETO ESTABLE
Affiant
Passport no. P5742426A
SUBSCRIBED AND SWORN to before me this 26th day of June at Lucena City,
Quezon, Philippines.
Doc. No. _______;
Page No. _______;
Book No. _______;
Series of 2019.